The average size of the second group is smaller than that of the first (see full data in table below). It comprises 89 pathfinders covering 2,183 GP practices and 15.5m patients from all health service regions in England. The pathfinders now cover 28.6m people, more than half the country.

The average second wave pathfinder comprises 24.5 GP practices with a combined list of 174,500. The first wave, announced in December, had an average size of 35 GP practices covering 239,000 people.

The second wave includes three pathfinders comprising a single GP practice: the Whitstable Practice and East Cliff in Ramsgate, both in Kent, and South Elmsall and Rycroft Consortium in Wakefield, Yorkshire. The smallest two pathfinders in the first wave both comprised three GP practices.

The largest pathfinder in the new group is three consortia in Leeds, which are running a combined pathfinder project. The first wave saw Manchester planning to use the same number of consortia to cover that city.

The new wave retains a mix of geographical consortia, with many based on primary care trust areas or other geographic units. There are also some existing organisations named.

"This second group of selected pathfinders is welcome evidence of widespread enthusiasm for taking these ideas forward," said health secretary Andrew Lansley.

"It is clear that GPs and nurses are ready and willing to take on commissioning responsibilities. The pathfinders to date demonstrate this, but most importantly the changes will enable them to make the decisions that better meet the needs of their local communities and improve outcomes for their patients."

"People said there would be no appetite for this," he said of the government's reforms. "Far from fearing new commissioning arrangements, over 140 GP led consortia have now come forward, covering over half the country."

He highlighted areas in which the NHS performed worse than other countries, saying: "In Denmark, Sweden, Norway, Austria and Poland you are less likely to die once admitted into hospital after a heart attack."

"Every year without modernisation the costs of our public services escalate," Cameron said, adding that the NHS faces pressures of an ageing population, conditions such as obesity and alcohol abuse and expensive new treatments and drugs.

"Pretending that there is some 'easy option' of sticking with the status quo and hoping that a little bit of extra money will smooth over the challenges is a complete fiction."

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